TOPIC: POLYCYSTIC OVARIAN SYNDROME (PCOS)
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Case Study 2: Antibiotic Stewardship in a Pediatric Patient with Pneumonia
Objective: Explore appropriate antibiotic selection, dosing, and resistance concerns in pediatric care.
Patient Profile:
Instructions for Students:
You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Reply to discussion1:
Nursing and Health Care Policy
History of Health Care Policy and Politics in Nursing
The evolution of health care policy and politics of nursing in the United States has changed dramatically since the late 19th century. At first, formal programs of nursing education and licensure statutes were implemented in the early 20th century to standardize and professionalize the practice of nursing (Smith, 2023). The formation of the American Nurses Association (ANA) further complemented the role of the nurses in advocacy within policy-making to ensure that they could make an input in legislation issues concerning patient care and the profession.
The mid-20th century was a point of inflexion with Medicare and Medicaid introduction in 1965. These initiatives extended healthcare access to vulnerable populations, boosting the number of nurses needed and changing the face of the provision of nursing care (Smith, 2023). Nursing policy developed gradually over the years, revolving around patient safety, workforce policy, and evidence-based practice. The enactment of the Affordable Care Act (ACA) in 2010 reconfirmed nurses’ position in health care reform via improved scope of practice and the incorporation of nurse practitioners within primary care service (Chiu et al., 2021).
Health policy in the era of the COVID-19 pandemic was centred around telehealth services expansion, workforce shortage mitigation, and reducing healthcare delivery inequities. Nurses were integral to policy actualization, with specific roles in vaccine dissemination and emergency preparedness planning (Smith, 2023). The continued development of health care policy continues to demonstrate consistency in showing the relevance of nursing contributions to policy that enhance patient outcomes and professional standards.
Structure of Health Care Delivery Systems
The United States healthcare delivery system consists of a mix of private and public institutions. These institutions offer various medical services, ranging from emergency care to specialty treatment (Smith, 2023). Primary care doctors serve as the initial contact for patients, offering preventive care and general management of chronic illnesses. They usually refer patients to specialists who render higher levels of care for complicated health issues.
Long-term care facilities, such as nursing homes, cater to the needs of elderly and disabled persons who require continuous medical care. Home health care, too, enables patients to receive medical attention within their premises, promoting comfort and reducing hospital re-admission rates (Smith, 2023). The federal administration funds and controls programs such as Medicare, Medicaid, and the Veterans Health Administration, while employer-sponsored and personal coverage plans come from private insurance providers.
Process of Health Care Policy
The process of health care policy includes several steps. It begins with problem identification. In nursing, this most often results from observed deficiencies in patient care, workforce problems, or regulatory problems. For instance, the demand for improved nurse staffing ratios arose from evidence linking reduced nurse-to-patient ratios to better patient outcomes (Chiu et al., 2021).
Policy formation follows, wherein stakeholders like nursing organizations, policymakers, and health care administrators propose potential solutions. The American Nurses Association (ANA) has a central role in forming and lobbying for policies that impact nursing practice and patient care (Clarke et al., 2021). Once a policy has been made, the step for adoption involves legislative approval at either state or federal levels.
Implementation is the second important step, coordinating health care facilities, policymakers, and working-level nurses. Smooth implementation depends on adequate funding, staff capacity building, and clear regulatory rules (Clarke et al., 2021). Policy evaluation, the final step, analyzes the performance of implemented measures to check if they contribute to desired healthcare outcomes. Shortfalls observed trigger amendments and further policy initiatives.
References
Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy Advocacy and Nursing Organizations: A Scoping Review. Policy, politics & nursing practice, 22(4), 271–291. https://doi.org/10.1177/15271544211050611
Clarke, J. M., Waring, J., Bishop, S., Hartley, J., Exworthy, M., Fulop, N. J., Ramsay, A., & Roe, B. (2021). The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis. BMC health services research, 21(1), 260. https://doi.org/10.1186/s12913-021-06272-z
Smith K. (2023). A (Brief) History of Health Policy in the United States. Delaware journal of public health, 9(5), 6–10. https://doi.org/10.32481/djph.2023.12.003
Reply to discussion2:
Nursing and Health Care Policy
Healthcare policy and politics play a significant role in shaping nursing practice and the overall healthcare delivery system in the United States. According to Barr (2023), over time, various policies have been developed to address issues such as healthcare access, quality of care, and the nursing workforce. Nurses have been involved in these changes, advocating for better patient care, professional development, and improved working conditions. Understanding the history, structure, and policy-making process is essential for nurses to actively participate in healthcare reform and influence policies that impact their profession and the patients they serve.
The history of healthcare policy in the United States has evolved over the years due to changes in societal needs, medical advancements, and political decisions. In the early 20th century, healthcare was largely unregulated, and access to care was limited, particularly for the poor and underserved populations. The establishment of the American Nurses Association (ANA) in 1896 marked an important milestone in nursing advocacy, as it aimed to improve professional standards and influence healthcare policy. In 1935, the Social Security Act was passed, providing federal funding for public health programs and recognizing the role of nurses in delivering healthcare services. Later, in 1965, the implementation of Medicare and Medicaid under the Social Security Act significantly expanded healthcare coverage for elderly and low-income individuals. These programs increased the demand for nursing services and highlighted the importance of nurses in patient care. In recent years, the Affordable Care Act (ACA) of 2010 further transformed the healthcare landscape by increasing access to insurance coverage and emphasizing preventative care as stated by Patel and Rushefsky (2019). The ACA also expanded the role of advanced practice registered nurses (APRNs), allowing them to provide more primary care services, especially in underserved areas.
The structure of healthcare policy in the United States involves multiple stakeholders, including federal and state governments, professional organizations, and healthcare institutions. The federal government, through agencies such as the Centers for Medicare & Medicaid Services (CMS), plays a key role in regulating healthcare laws and funding programs that affect nursing and patient care. Congress is responsible for passing healthcare legislation, which directly impacts the nursing profession. At the state level, each state’s board of nursing establishes nurse practice acts that define the scope of nursing practice and licensure requirements. These laws determine what nurses can and cannot do within their profession, influencing the delivery of care. Professional organizations, such as the ANA and the National League for Nursing (NLN), advocate for policies that benefit nurses and patients. They work to influence lawmakers, conduct research, and provide resources to support nursing professionals (Stievano et al., 2019). Additionally, healthcare institutions, such as hospitals and clinics, develop internal policies that affect how nurses carry out their roles and responsibilities. These organizations set workplace standards, staffing policies, and protocols that shape nursing practice and patient outcomes.
The process of healthcare policy development and implementation follows several steps. First, an issue must be identified and placed on the policy agenda. This could be a concern related to patient safety, nurse staffing ratios, or healthcare access. Once an issue is recognized, the policy formulation stage begins, where lawmakers, healthcare professionals, and advocacy groups develop proposals to address the problem. This stage involves research, debate, and collaboration to create effective solutions (Weissert & Weissert, 2019). After formulating a policy, it moves to the implementation phase, where government agencies and healthcare institutions put it into practice. This may involve changes in hospital procedures, training programs for nurses, or adjustments in insurance coverage. Finally, policies undergo evaluation to assess their impact on patient care, nursing practice, and overall healthcare outcomes. If a policy is ineffective or problematic, it may be revised or replaced. Nurses play a critical role in this process by providing feedback, conducting research, and advocating for necessary changes.
In conclusion, healthcare policy and politics significantly impact nursing practice and the healthcare system in the United States. Over the years, various policies have been introduced to improve access to care, enhance patient outcomes, and support the nursing workforce. The structure of healthcare policy involves multiple levels of government, professional organizations, and healthcare institutions that work together to regulate and implement healthcare laws. Understanding the policy-making process allows nurses to actively engage in advocacy efforts and influence decisions that affect their profession and the well-being of their patients.
References
Barr, D. A. (2023). Introduction to US health policy: The organization, financing, and delivery of health care in America. JHU Press. https://books.google.com/books?hl=en&lr=&id=PvnKEAAAQBAJ&oi=fnd&pg=PP1&dq=history,+structure,+and+process+of+health-care-+policy+and+politics+in+nursing+and+the+health+care+delivery+systems+in+the+United+States.&ots=hfzAQs_9aR&sig=JN2xnOGBeZm0fixlM96v1P3p7W4Links to an external site.
Patel, K., & Rushefsky, M. E. (2019). Healthcare politics and policy in America. Routledge. https://www.taylorfrancis.com/books/mono/10.4324/9780429397875/healthcare-politics-policy-america-kant-patel-mark-rushefskyLinks to an external site.
Stievano, A., Caruso, R., Pittella, F., Shaffer, F. A., Rocco, G., & Fairman, J. (2019). Shaping nursing profession regulation through history–a systematic review. International nursing review, 66(1), 17-29. https://onlinelibrary.wiley.com/doi/abs/10.1111/inr.12449Links to an external site.
Weissert, W. G., & Weissert, C. S. (2019). Governing health: The politics of health policy. Johns Hopkins University Press. https://books.google.com/books?hl=en&lr=&id=cEbzDwAAQBAJ&oi=fnd&pg=PP6&dq=history,+structure,+and+process+of+health-care-+policy+and+politics+in+nursing+and+the+health+care+delivery+systems+in+the+United+States.&ots=ReodTd6gES&sig=DXCMUQZlsXz0LS6zH54xcArA_tYLinks to an external site.
You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Reply to discussion1:
One of the most fulfilling realities of nursing is the opportunity that it creates for life-long long learning. This endeavor to be competent extends beyond understanding advances in medicine and clinical skills, it involves a commitment to understanding our patients, specifically their culture. The concept of transcultural nursing includes a framework that describes six cultural phenomena that are present in all cultures. These phenomena include: communication, space, social organization, time, environmental control and biological variations.
Communication focuses on both verbal and non-verbal cues. This would include selecting the appropriate language in which the patient feels most comfortable communicating in, even if that means using a translator. Special attention should be given to body language, and speaking clearly, as well as allowing for silence to give patients time to respond. Studies have shown that ineffective communication, specifically task-based care ,creates a barrier to patient centered care and communication. (Kwame & Petrucka, 2021)
Space requires an understanding of how to appropriately use physical proximity. This includes awareness of preferences around comfort zones and personal space.
Understanding the influence of social organization is important because degrees of involvement from the support system will vary greatly between cultures. Additionally, an understanding of the stake each member of the support systems has in the patient’s care can impact health outcomes. It’s been shown that increased social support yields favorable results such as increased self-management and increased medication adherence. (Shahin, Kennedy, & Stupans, 2021)
A patient’s relationship with time can have significant implications in their care. An example of this would be their relationship with punctuality or time spent on activities related to their care.
Environmental control is an important consideration as values and beliefs regarding the physical environment and its impact on health and recovery can vary greatly between groups. Respecting cultural practices and finding ways to honor or incorporate traditions in the treatment can be useful
Biological variations impact susceptibility to disease and illness, genetic predisposition to disease, and response to certain treatment
A nursing practice that is rooted in intention and desire to deliver culturally competent care implies a desire to improve health care quality, deliver individual care, and enhance equity in healthcare delivery & Stubbe, 2020). It is estimated that by 2050, 50% of the population in the United States will be comprised of minorities, further highlighting the critical importance of this concept. (Nair & Adetayo, 2020). Having an awareness of these six cultural phenomena and understanding how to incorporate them in nursing practice is the responsibility of all nurses.
References
Kwame, A., Petrucka, P.M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs 20, 158. https://doi.org/10.1186/s12912-021-00684-2.
Nair, L., & Adetayo, O. A. (2020). Cultural Competence and Ethnic Diversity in Healthcare. Plastic and reconstructive surgery. Global open, 7(5), e2219. https://doi.org/10.1097/GOX.0000000000002219Links to an external site.
Shahin, W., Kennedy, G. A., & Stupans, I. (2021). The association between social support and medication adherence in patients with hypertension: A systematic review. Pharmacy practice, 19(2), 2300. https://doi.org/10.18549/PharmPract.2021.2.2300
Stubbe D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (American Psychiatric Publishing), 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041
reply to discussion2:
o provide culturally diverse nursing care, describe the six cultural phenomena that are evident in all cultural groups.
There are six different cultural phenomena that are evident in all cultural groups. Those six cultural phenomena are space, communication, time, social organization, environment control and biological variations. These phenomena are there to understand how culture can impact the patient care and how they can clear any miscommunication and can improve patient care.
Communication is a very important factor in nursing for many different reasons. Communication is going to enhance quality of care to patients and it is going to effectively improve teamwork among other healthcare professionals that are involved in providing care for the patients. The patients are also to care for their own health and participate more if there is clear communication between the patient and the healthcare providers. There is a current problem in clear communication due to a difference in culture and language as a barrier to health. There are many different cultures and many different religions and some of these patients are very unique and may come from many different cultures and religions. If there is a language or a culture barrier between the nurse and the patients, this can lead to an impaired healing process (Giger, 2021, pg. 20). It is very important for nurses to have effective communication not just with the patients but also with their family members and with other healthcare members that are involved in the patient’s care. This factor is very important because it help to educate the patient on their condition and their medication regimen. Clear and effective communication is going to enable nurses to care for their patients. Patients will be aware of their conditi0on and what interventions must be conducted to improve their health. The patients will also have a better understanding on how to administer their own medication at home (Wieke, 2021).
The second phenomena is space and this related to personal space and different levels of comfort with others. Personal space can also have a cultural variation. In many different cultures, personal space is very important and could mean different things for different cultures. Nurses have to be mindful and respectful in regards to personal space because it can be offensive in some cultures and it can be considered therapeutic in others (Roxberg, 2020). Biological variances is another factor that nurses should be aware of in order to understand the patient’s and their health. Understanding genetics and their ethnic background can also help to understand the patient’s condition and can aid in assessment. Environmental control is very important for the patient’s perception of their health and engagement in their health in terms of self-efficacy. Time is also very important when it comes to a patient’s health because they have to be mindful of their medication regimen and to take medication when it’s the appropriate time. The patients also have to be aware of their appointment times and to relay their availability to the healthcare providers for their check-ins. Social organization is also very important to understand for nurses because that can influence the patient’s behaviors and their belief. Because of certain conditions in patient’s they may need some social support and they may also have some spiritual needs as well.
Reference:
Giger, J. N., & Haddad, L. (2021). Transcultural Nursing: Assessment and Intervention (8th ed.).
Roxberg, Å., Tryselius, K., Gren, M., Lindahl, B., Werkander Harstäde, C., Silverglow, A., Nolbeck, K., James, F., Carlsson, I. M., Olausson, S., Nordin, S., & Wijk, H. (2020). Space and place for health and care. International journal of qualitative studies on health and well-being, 15(sup1), 1750263. https://doi.org/10.1080/17482631.2020.1750263
Wieke Noviyanti, L., Ahsan, A., & Sudartya, T. S. (2021). Exploring the relationship between nurses’ communication satisfaction and patient safety culture. Journal of public health research, 10(2), 2225. https://doi.org/10.4081/jphr.2021.2225
Assignment on ethical dilemma
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